Sperm exposure and development of preeclampsia

doi:10.1067/mob.2003.401

American Journal of Obstetrics and Gynecology

Volume 188, Issue 5, May 2003, Pages 1241-1243

https://doi.org/10.1067/mob.2003.401 Get rights and content

Abstract

Objective: Length of sperm exposure has been proposed to influence the risk of preeclampsia. The main objective was to determine the relationship between extent of exposure to sperm, both before and during pregnancy, and the risk of preeclampsia. Study Design: A case-control design was used where women with preeclampsia (cases) were matched with two women without preeclampsia (controls) by age and parity. Data were analyzed by Student t test, χ² test, and logistic regression analysis. Results: A total of 113 cases were compared with 226 controls. Women with a short period of cohabitation (<4 months) who used barrier methods for contraception had a substantially elevated risk for development of preeclampsia compared with women with more than 12 months of cohabitation before conception (odds ratio 17.1, P =.004). Conclusion: Fewer than 4 months of cohabitation among users of barrier methods for contraception is associated with a significantly increased risk for preeclampsia. (Am J Obstet Gynecol 2003;188:1241-3.)

Section snippets

Material and methods

The subject population consisted of Hispanic women who were delivered at Ben Taub General Hospital between July 2000 and September 2001. Approximately 5500 deliveries occur at this hospital annually. The women were recruited immediately post partum. Questionnaires were administered by trained Spanish-speaking female medical students in a private setting.

Our sample size estimation was based on statistical as well as logistic reasons. We calculated the sample size assuming an α of.05, a β of.20

Results

Patient characteristics are shown in Table I.

. Baseline characteristics

Empty Cell	Cases (n = 113)	Controls (n = 226)
Age (y)	26.3	25.9
Parity	2.1	2.2
Body mass index	27.4	25.3*
Lifetime partners	1.7	1.6
New partner (%)	13	16
Previous preeclampsia (%)	15.9	2.7*
Chronic hypertension (%)	6.2	0.9*
Previous blood transfusion (%)	2.7	5.3
Gestational diabetes (%)	16.8	12.4
Diabetes (%)	2.7	1.8
Multifetal pregnancy (%)	3.5	0*
Connective tissue disease (%)	1.8	0†
Smoking (%)	3.5	2.3
History of abortion (%)	19.5	11.5†
*P <.001. †P <.05.

We performed a

Comment

This study suggests a relationship between sperm exposure and risk for preeclampsia. On the basis of our findings, even a short period of exposure to sperm seems to offer protection against development of preeclampsia. Specifically, only women with limited exposure (primigravid barrier method users in unions of <4 months) seem to be at elevated risk for development of preeclampsia. Exposure to seminal fluids before conception could result in down-regulation of the mother's immune response to

Acknowledgements

We thank Jennifer Cooper, Gwendolyn Henao, Jenn Larson Kalisvaart, Christina Bloem, Carolyn Yang, Shanna Shahid, and Angela Shoher for their help with data collection.

References (7)

PY Robillard et al.
Association of pregnancy-induced hypertension with duration of sexual cohabitation before conception
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GN Smith et al.
Increased incidence of preeclampsia in women conceiving by intrauterine insemination with donor versus partner sperm for treatment of primary infertility
Am J Obstet Gynecol
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American College of Obstetricians et al.
Hypertension in pregnancy
(1996)

There are more references available in the full text version of this article.

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Preeclampsia epidemiology(ies) and pathophysiology(ies)
2024, Best Practice and Research: Clinical Obstetrics and Gynaecology
Preeclampsia/eclampsia was first described 2000 years ago. Concepts guiding diagnosis have changed over time making longitudinal studies challenging. Similarly, concepts of pathophysiology have evolved from eclampsia as a pregnancy seizure disorder to preeclampsia as a hypertensive and renal disorder to our current concept of a preeclampsia as a pregnancy specific, multisystemic inflammatory disorder. Although preeclampsia is pregnancy specific and many pathophysiologic findings begin to resolve with delivery, its impact extends beyond pregnancy. The risk of cardiovascular and neurological disease is increased after pregnancy in women who have had preeclampsia. The disorder is not a disease, but a syndrome and emerging data indicate multiple pathways to the syndrome. It is likely that our failure to have a major impact on prediction and prevention despite a large increase in understanding is due to the existence of multiple subtypes of preeclampsia. This concept should guide future research.
Higher incidence of preeclampsia among participants undergoing in-vitro fertilization after fewer sperm exposures
2023, European Journal of Obstetrics and Gynecology and Reproductive Biology
Evaluation of preeclampsia (PE) incidence among participants undergoing in vitro fertilization (IVF) after various cycles of sperm donation (SD) via intrauterine inseminations (IUI) or IVF.
A retrospective case-control study was conducted at a single tertiary medical center between 2011 and 2019 which included participants who conceived via IVF using SD from a single sperm bank and had a successful singleton birth at Sheba Medical Center. The study cohort was divided into two groups: Group 1 (participants who conceived via IVF after 0–1 cycles of IUI or IVF from the same sperm donor) and Group 2 (participants who conceived via IVF after 2 or more cycles of IUI or IVF from the same sperm donor).
Baseline characteristics and pregnancy outcomes between the two groups were compared. In addition, a comparison between the study groups and a control of participants of the same age who conceived spontaneously and had a singleton birth at Sheba Medical Center during the same period with a record of up to two previous deliveries was done.
A total of 228 participants conceived through IVF from SD and met the inclusion criteria. Of these, 110 were defined as Group 1 and 118 as Group 2. The participants showed no differences in their age, gravidity and parity, chronic medical conditions, or history of pregnancy complications.
Preeclampsia was positively associated with Group 1 (9 [8.2%] vs. 2 [1.7%], P = 0.022).
PE was observed to be more prevalent in Group 1 (P < 0.001) when compared to a control group of 45,278 participants who conceived spontaneously. No significant differences were observed in comparing Group 2 with the same control group.
The incidence of PE was higher among participants who were exposed to 0–1 IUI or IVF cycles than in those who were exposed to 2 or more cycles of IUI or IVF from the same sperm donor. On comparing both groups with a control group, the incidence of PE was higher in participants who were exposed to 0–1 cycles, while there was no difference in participants exposed to 2 or more cycles.
If there is a statistically significant increase in the incidence of PE when conception occurred following fewer sperm exposures, then there may be a correlation between these two. The reason for this is not entirely clear, but based on former literature, we hypothesize it may be related to the fact that repeated exposures to paternal antigens may alter the maternal immune response causing a better adaptation to the semi-allogenic nature of the fetus, its paternal half.
Obstetric and perinatal risks after the use of donor sperm: A systematic review and meta-analysis
2022, European Journal of Obstetrics and Gynecology and Reproductive Biology
Donor sperm is widely used in infertility treatments. The purpose of the study was to investigate, whether use of donor sperm in intrauterine insemination (IUI) or in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatments affect maternal and perinatal risks compared with spontaneously conceived pregnancies or use of partner sperm in IUI, IVF or ICSI. We provide a systematic review and meta-analyses on the most clinically relevant obstetric and perinatal outcomes after use of donor sperm compared with partner sperm: hypertensive disorders of pregnancy, preeclampsia, low birth weight, and preterm birth. Our meta-analyses showed an increased risk for preeclampsia (pooled adjusted odds ratio (aOR) 1.77, 95% CI 1.26–2.48) and hypertensive disorders of pregnancy (pooled aOR 1.55, 95%, CI 1.20–2.00) in pregnancies resulting from IUI with donor sperm compared with IUI with partner sperm. No increased risk was seen for low birth weight or preterm birth after the use of donor sperm in IUI compared with the use of partner sperm in IUI. Subgroup analysis for singletons only did not change these results. The meta-analysis on low birth weight showed a lower risk after in IVF with donor sperm compared with IVF with partner sperm (pooled aOR 0.89, 95% CI 0.83–0.94). For hypertensive disorders of pregnancy, preeclampsia and preterm birth, no difference was found between IVF with donor sperm vs. partner sperm. Patients need to be informed about the moderately increased risk of hypertensive disorders of pregnancy and preeclampsia in pregnancies after IUI with donor sperm.
Type of paternal sperm exposure before pregnancy and the risk of preeclampsia: A systematic review
2020, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
Fig. 1 shows the flow diagram of information derived from our review of potentially relevant articles (Fig. 1, Supplementary Table 1). Seven studies [14–20] including 7125 pregnant women were included in this systematic review. The majority of the included women were nulliparous, although three studies [16–18] also included multiparous women (Table 1).
The aim of this systematic review was to evaluate the role of paternal sperm exposure before pregnancy on the risk of preeclampsia.
The search was conducted using electronic databases from inception of each database through October 2019. Review of articles also included the abstracts of all references retrieved from the search. Only studies evaluating exposure to paternal sperm before pregnancy on the risk of preeclampsia in the subsequent pregnancy were included. Exposure group was defined as significant exposure to paternal sperm, either measured by sexual cohabitation, oral sex habit, or by absence of barrier methods. Control groups was defined as minimal exposure to paternal sperm, either measured by lack of sexual cohabitation or oral sex habit, or by use of barrier methods. Sperm exposure identifiable before pregnancy that may be suspected to modify the risk of preeclampsia was examined. The primary outcome was the incidence of preeclampsia. Subgroup analyses by parity and type of sperm exposure were planned. All analyses were carried out using the random effects model. The pooled results were reported as the OR with 95 % confidence interval (CI). Heterogeneity was measured using I-squared (Higgins I²).
Seven studies including 7125 pregnant women were included in this systematic review. Overall, the incidence of preeclampsia was similar in women with a higher overall sperm exposure compared to controls, 774/5512 (14 %) vs 220/1619 (13.6 %); OR 1.04, 95 % CI 0.88–1.22, respectively. The incidence of preeclampsia was significantly reduced in women with a higher overall sperm exposure when including only nulliparous women, 643/3946 (16.1 %) vs 170/725 (23.4 %); OR 0.63, 95 % CI 0.52 to 0.76. Significant lower rate of preeclampsia was also found for ≥12-month sexual cohabitation, 494/3627 (13.6 %) vs 123/691 (17.8 %); OR 0.73, 95 % CI 0.59−0.90. Significantly higher rate of preeclampsia was reported in women not using barrier methods, 315/1904 (16.5 %) vs 103/962 (10.7 %); OR 1.65, 95 % CI 1.30–2.10.
Paternal sperm exposure in nulliparous women and sexual cohabitation > 12 months before pregnancy are associated with a decreased risk of preeclampsia.
Impact of the mode of conception on gestational hypertensive disorders at very advanced maternal age
2020, Reproductive BioMedicine Online
To study gestational hypertensive disorders in oocyte donation pregnancies compared with other modes of conception at very advanced maternal age.
A historical cohort study of all women aged 45–47 years who gave birth to singletons at a tertiary medical centre between March 2011 and May 2018, at 24 weeks’ gestation or later. Pregnancy outcomes were compared between donor oocyte (IVF-OD), IVF using autologous oocytes (IVF-A) and naturally conceived pregnancies. A multivariate logistic regression was used to evaluate the association between the mode of conception and gestational hypertensive disorders.
The final analysis included 159, 68 and 73 patients in the IVF-OD, IVF-A and natural conception groups, respectively. The rate of gestational hypertensive disorders was significantly higher among those who conceived by IVF compared with those who conceived naturally but did not differ between the two IVF groups (27.0% for IVF-OD, 19.1% for IVF-A, P = 0.204; 5.5% for natural conception, P < 0.001 and P = 0.013 compared with IVF-OD and IVF-A, respectively). The results remained similar in a multivariate logistic regression analysis. The rate of Caesarean deliveries was significantly higher in the IVF-OD and IVF-A groups compared with the natural conception group (83.6%, 70.6% and 37.0%, respectively, P < 0.001), but other pregnancy outcomes did not differ between the groups.
IVF pregnancies in the late fifth decade of life were associated with significantly higher rates of gestational hypertensive disorders compared with naturally conceived pregnancies. No difference existed between the two IVF groups. These results may highlight the impact of IVF itself on gestational hypertensive disorders at very advanced maternal age.
Prior abortion history and pregnancy hypertensive disorders in primiparous gravidae
2018, Pregnancy Hypertension
To explore the relationship between prior abortion history with incidence of pregnancy hypertensive disorders (PHD), including gestational hypertension (GH) and pre-eclampsia (PE), to determine whether the secular increases in GH and PE in developed countries could be related in part to the decreased incidence of abortion.
A single center retrospective cohort study on primiparous Chinese gravidae managed in 1997–2015 in our hospital.
The occurrence of PHD, GH and PE with respect to the presence or otherwise of prior abortions, with the analysis stratified for risk factors that include advanced age, high body mass index (BMI), history of medical disorders, birth before 34 weeks, and maternal hepatitis B virus (HBV) infection and rubella non-immunity which have been shown to influence the occurrence of PHD in our population.
The 23,698 (39.3%) of the 60,335 gravidae in the cohort with ≥ one prior abortion had higher incidence of advanced age, HBV infection, rubella non-immunity, and high BMI, but lower incidence of PHD, GH, PE and birth before 34 weeks gestation. The difference in the incidence of GH and PE between gravidae having one versus those with two or more abortions was minimal, and the effect of abortion on PHD was influenced by the other risk factors. On regression analysis, prior abortion reduced PHD (aRR 0.761, 95% CI 0.684–0.846), GH (aRR 0.660, 95% CI 0.563–0.773), and PE (aRR 0.857, 95% CI 0.745–0.987).
Prior abortion reduces the subsequent development of GH and PE in primiparous women.

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^☆: Supported by a grant from the Houston Gynecological and Obstetrical Society.

^☆☆: Reprint requests: Jon Ivar Einarsson, MD, Baylor College of Medicine, Department of Obstetrics and Gynecology, 6550 Fannin, Suite 901, Houston, TX 77030. E-mail: [email protected]

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General Obstetrics and Gynecology ObstetricsSperm exposure and development of preeclampsia☆,☆☆

Abstract

Section snippets

Material and methods

Results

Comment

Acknowledgements

Lancet

Am J Obstet Gynecol

Hypertension in pregnancy

General Obstetrics and Gynecology Obstetrics
Sperm exposure and development of preeclampsia☆,☆☆